Swine Flu

This is provided as a public service. There is no intention to increase alarm but there is mis-information on some of the news and social media (e.g. ‘Twitter”). So this is the latest data on the “swine flu” which the World Health Organization (WHO) calls “swine influenza A(H1N1)”. If you are concerned or know someone who only has access to popular media, such as television, the following may be useful.

The following was current as of April 28, 2009. For additional information, see the WHO website at http://www.who.int/csr/disease/swineflu/en/ and information is also available at the Centers for Disease Control and Prevention (CDC) website http://www.cdc.gov/swineflu/

According to the CDC, it is "Your Online Source for Credible Health Information". The CDC has this statement on its website:

What You Can Do to Stay Healthy
There are everyday actions people can take to stay healthy.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way.

Try to avoid close contact with sick people.

• Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
• If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Additional Information from the WHO website:

According to the WHO website "update 3" April 27, 2009, the United States Government has reported 40 laboratory confirmed human cases of swine influenza A(H1N1), with no deaths.

1. According to the WHO “There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.”
2. WHO has issued a “Phase 4” alert, which means that swine flue “is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.””
3. This is from the WHO website: "The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion."
4. Swine Flu Frequently Asked Questions from the World Health Organization website http://www.who.int/csr/swine_flu/swine_flu_faq.pdf

The following is from the WHO faq document on the website:

What is swine influenza?
Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses. Morbidity tends to be high and mortality low (1-4%)…. Although swine influenza viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans.

What are the implications for human health?
Outbreaks and sporadic human infection with swine influenza have been occasionally reported. Generally clinical symptoms are similar to seasonal influenza but reported clinical presentation ranges broadly from asymptomatic infection to severe pneumonia resulting in death.

Since typical clinical presentation of swine influenza infection in humans resembles seasonal influenza and other acute upper respiratory tract infections, most of the cases have been detected by chance through seasonal influenza surveillance. Mild or asymptomatic cases may have escaped from recognition; therefore the true extent of this disease among humans is unknown.

How do people become infected?
People usually get swine influenza from infected pigs, however, some human cases lack contact history with pigs or environments where pigs have been located. Human-to-human transmission has occurred in some instances but was limited to close contacts and closed groups of people.

Is it safe to eat pork and pork products?
Yes. Swine influenza has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The swine influenza virus is killed by cooking temperatures of 160;F/70;C, corresponding to the general guidance for the preparation of pork and other meat.

Is there a human vaccine to protect from swine influenza?
There are no vaccines that contain the current swine influenza virus causing illness in humans. It is not known whether current human seasonal influenza vaccines can provide any protection. Influenza viruses change very quickly. It is important to develop a vaccine against the currently circulating virus strain for it to provide maximum protection to the vaccinated people. This is why WHO needs access to as many viruses as possible in order to select the most appropriate candidate vaccine virus.

What drugs are available for treatment?
There are two classes of such medicines, 1) adamantanes (amantadine and remantadine), and 2) inhibitors of influenza neuraminidase (oseltamivir and zanamivir). Most of the previously reported swine influenza cases recovered fully from the disease without requiring medical attention and without antiviral medicines.

Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of treatment. The viruses obtained from the recent human cases with swine influenza in the United States are sensitive to oselatmivir and zanamivir but resistant to amantadine and remantadine.
Information is insufficient to make recommendation on the use of the antivirals in treatment of swine influenza virus infection. Clinicians have to make decisions based on the clinical and epidemiological assessment and harms and benefit of the treatment of the patient. For the ongoing outbreak of the swine influenza infection in the United States and Mexico, the national and the local authorities are recommending to use oseltamivir or zanamivir for treatment of the disease based on the virus’s susceptibility profile.

How can I protect myself from getting swine influenza from infected people?
In the past, human infection with swine influenza was generally mild but is known to have caused severe illness such as pneumonia For the current outbreaks in the United States and Mexico however, the clinical pictures have been different. None of the confirmed cases in the United States have had the severe form of the disease and the patients recovered from illness without requiring medical care. In Mexico, some patients reportedly had the severe form of the disease.

To protect yourself, practice general preventive measures for influenza:

• Avoid close contact with people who appear unwell and who have fever and cough.
• Wash your hands with soap and water frequently and thoroughly.
• Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active.

If there is an ill person at home:

• Try to provide the ill person a separate section in the house. If this is not possible, keep the patient at least 1 meter in distance from others [Note: 1 meter is 3.28 feet, or about 3 feet and 3 inches].
• Cover mouth and nose when caring for the ill person. Masks can be bought commercially or made using the readily available materials as long as they are disposed of or cleaned properly.
• Wash your hands with soap and water thoroughly after each contact with the ill person.
  Try to improve the air flow in the area where the ill person stays. Use doors and windows to take advantage of breezes.
• Keep the environment clean with readily available household cleaning agents.
• If you are living in a country where swine influenza has caused disease in humans, follow additional advice from national and local health authorities.

What should I do if I think I have swine influenza?
If you feel unwell, have high fever, cough and/or sore throat:

• Stay at home and keep away from work, school or crowds as much as possible.
• Rest and take plenty of fluids.
• Cover your mouth and nose with disposable tissues when coughing and sneezing and dispose of the used tissues properly.
• Wash your hands with soap and water frequently and thoroughly, especially after coughing or sneezing.
• Inform family and friends about your illness and seek help for household chores that require contact with other people such as shopping.

If you need medical attention:

• Contact your doctor or healthcare provider before travelling to see them and report your symptoms.
• Explain why you think you have swine influenza (for example, if you have recently travelled to a country where there is a swine influenza outbreak in humans). Follow the advice given to you for care.
• If it is not possible to contact your healthcare provider in advance, communicate your suspicion of having swine influenza immediately upon arrival at the healthcare facility.
• Take care to cover your nose and mouth during travel.